Adjustable distraction cage with linked locking mechanisms

ABSTRACT

A spinal implant which is configured to be deployed between adjacent vertebral bodies. The implant has at least one extendable support element with a retracted configuration to facilitate deployment of the implant and an extended configuration so as to expand the implant and effectively distract the disc space, stabilize the motion segments and eliminate pathologic spine motion. The implant has a minimal dimension in its unexpanded state that is smaller than the dimensions of the neuroforamen through which it typically passes to be deployed within the intervertebral space. The implant is provided with a locking system having a plurality of linked locking elements that work in unison to lock the implant in an extended configuration. Bone engaging anchors also may be provided to ensure secure positioning.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 15/377,377, filed Dec. 13, 2016, which is a continuation ofU.S. patent application Ser. No. 14/644,969, filed Mar. 11, 2015, whichis a continuation of U.S. patent application Ser. No. 13/843,390, filedon Mar. 15, 2013, which is a continuation-in-part of U.S. patentapplication Ser. No. 12/787,281, filed on May 25, 2010, which is acontinuation-in-part of International Application No. PCT/US2009/67446filed Dec. 10, 2009, which is a continuation of U.S. patent applicationSer. No. 12/548,260, filed on Aug. 26, 2009. U.S. patent applicationSer. No. 12/548,260 is a continuation-in-part of U.S. patent applicationSer. No. 12/072,044, filed on Feb. 22, 2008, and is acontinuation-in-part of U.S. patent application Ser. No. 12/380,840,filed on Mar. 4, 2009, which claims the benefit of the filing date ofU.S. Provisional Patent Application No. 61/201,518, filed on Dec. 10,2008, the disclosures of which are hereby incorporated herein byreference.

FIELD OF THE INVENTION

The invention relates to devices and methods for stabilizing thevertebral motion segment. More specifically, the field of the inventionrelates to an expandable spinal implant with locking elements configuredto lock the implant in an expanded configuration within anintervertebral space to provide controlled spinal correction in threedimensions for improved spinal intervertebral body distraction andfusion.

BACKGROUND

A conventional spine cage or implant is characterized by a kidney beanshaped body which is typically inserted posteriorly through theneuroforamen of the distracted spine after a trial implant creates apathway. Existing devices for interbody stabilization have important andsignificant limitations, including inability to expand and distract theend plates or to fix the device in place to prevent relative movementbetween the device and an adjacent vertebral body. Current devices forinterbody stabilization include static spacers composed of titanium,PEEK, and high performance thermoplastic polymer produced by VICTREX,(Victrex USA Inc, 3A Caledon Court; Greenville, S.C. 29615), carbonfiber, or resorbable polymers. Moreover, current interbody spacers donot maintain interbody lordosis and can contribute to the formation of astraight or even kyphotic segment and the clinical problem of “flatbacksyndrome.” Separation of vertebral end plates increases space availablefor the neural elements, specifically the neural foramen. Existingstatic cages do not reliably improve space for the neural elements.Therefore, what is needed is a spinal implant that will provide spacefor the neural elements posteriorly between the vertebral bodies, or atleast maintain the natural bone contours to avoid neuropraxia (nervestretch) or encroachment.

Conventional devices for intervertebral body stabilization include poorinterface between bone and the biomaterial of the device. Conventionalstatic interbody spacers form a weak interface between bone andbiomaterial. Although the surface of such implants is typically providedwith a series of ridges or coated with hydroxyapetite, the ridges may bein parallel with applied horizontal vectors or side-to-side motion. Thatis, the ridges or coatings on the implant offer little resistance tomovement applied to either side of the end plates. Thus, nonunion iscommon in allograft, titanium and polymer spacers, due to motion betweenthe implant and host bone.

SUMMARY OF THE DISCLOSURE

This invention is generally directed to a spinal implant for insertionbetween superior and second vertebral end plates after partial or totalremoval of a spinal disc. The spinal implant embodying features of theinvention has a contracted configuration for easy installation betweenadjacent vertebral bodies and an expanded configuration to support thevertebrae in a desirable position. More specifically, the implant has aplurality of inter-engagable elements which locks the implant in anexpanded configuration to hold the vertebral or joint sections in thedesired positions.

The invention is particularly directed to a spinal implant suitable forplacement between superior and interior vertebral bodies. The spinalimplant has a first member or top plate for engaging an end of thesuperior vertebral body and a second member or base for engaging an endof the inferior vertebral body and has one or more extendable supportelements preferably with one or more top end plates that engagevertebral bodies in the expanded configuration. The one or moreextendable support elements have a first contracted configuration tofacilitate deployment of the implant between the superior and inferiorvertebral bodies and safely past sensitive neural elements and a secondor an extended configuration to engage the end plates of the vertebralbodies. The implant has a locking system with linked locking elementsthat mechanically engage or interlock with the extendable supportelement or the first member to lock the implant between the superior andinferior vertebral bodies in an expanded configuration.

The extendable support element(s) may be extended in a variety of wayssuch as with fluid pressure, e.g. hydraulic fluid or gas, by mechanicalforce, such as a threaded connection with a rotating driving member orother suitable means. Fluidic displacement is preferred. The extendablesupport element(s) are disposed in cylinders which support and guide theextendable support elements when they are extended. However, the lockingsystem is separate from the extendable support member and cylinderreceiving the supporter member, although the extending support membermay initiate the locking system and the support member and cylinder mayhave lock support members attached thereto.

In one exemplary system, the spinal implant having features of theinvention comprises an inferior pressure applying member or base with afirst bone engaging surface, one or more extendable support memberscooperating with the base and a superior pressure applying member suchas a top end plate with a second bone engaging surface that is coupledto the at least one extendable member. The spinal implant preferably hasa plurality of engaging locking elements that are configured toindependently lock one or more of the extendable support members orpressure applying members in an extended configuration to therebyprovide desired disc height between adjacent vertebrae.

The spinal implant or selectively expanding spine cage (SEC) embodyingfeatures of the invention is particularly suitable for posterior ortransforaminal insertion between superior and inferior vertebral endplates as described in copending application Ser. No. 11/535,432, filedSep. 26, 2006, and Ser. No. 11/692,800, filed Mar. 28, 2007. The implanthas a contracted or unexpanded configuration which allows easydeployment and is typically about 0.5 to about 1 cm in maximum shorttransverse dimension so as to enable minimally invasive insertionposteriorly between vertebral pedicles through a working space ofapproximately 1 cm in diameter.

In one exemplary embodiment, the spinal implant for placement betweenadjacent vertebral bodies as described above has an upper locking memberwith stepped supporting surfaces on the underside thereof and a lowerlocking member with stepped supporting surfaces on the top side thereofwhich are configured to engage the stepped supporting surface of theupper locking member to lock the implant in an extended configuration.Extension of the expandable members, such as bellows or pistons; orother appropriately sized mechanisms, such as cams or screws, to raisethe superior pressure applying member increases longitudinal spacingbetween the upper and lower locking members. Relative motion, rotationalor linear, between the upper and lower locking members causes thestepped supporting surfaces of the lower locking members and the steppedsupporting surfaces of the upper locking members to re-engage to fix thelocking members in an increased spaced apart relationship and therebylock the implant in the extended configuration.

Since the vertebral end plates are held together at one end by aligament much like a clamshell, as the implant expands against thevertebral end plates, the amount of vertical expansion can be adjustedto create the desired anterior/posterior correction angle.

A minimally invasive downsized insertion tool, such as described in theabove referenced applications, both inserts the unexpanded implantposteriorly and provides the hydraulic or mechanical lines communicatingwith the interior of the implant. The insertion tool may also provide aline for communicating the liquid or slurry bone graft material into theintervertebral space for subsequent fusion. Advantageously, hydrauliclines are small size tubing to allow for high hydraulic pressure withoutdanger of the lines bursting.

Due to the mechanical advantage provided by a hydraulic system or aproximally operated mechanical system, the implant has minimized sizeand diameter in its unexpanded state that is smaller than the diameterof a prepared neuroforamen. The implant thus can be insertedtransforaminally and engaged between the end plates of the adjacentvertebra to effectively distract the intervertebral area, restore spacefor neural elements, stabilize the motion segment and eliminatepathologic segmental motion. The implant enhances spine arthrodesis bycreating a rigid spine segment.

The implant is preferably provided with a hollow interior to enable acomparatively large quantity of bone growth conductive or inductiveagents to be contained therein that through openings communicatedirectly to adjacent bone. Importantly, this results in fixation forcesgreater than adjacent bone and soft tissue failure forces. The implantcan be used to promote fusion, and/or to correct deformities such asscoliosis, kyphosis, and spondylolisthesis.

The clinical goals of the implant and the method for its insertionprovide a minimally invasive risk of trauma to nerve roots, reduce pain,improve function, and permit early mobilization of the patient afterfusion surgery. The fixation elements maintain the implant in a desiredposition until healing (fusion or arthrodesis) occurs. At this point,the implant is incorporated inside bone and its role becomes quiescent.

Thus, a feature of the invention is that an implant can be insertedposteriorly between vertebral pedicles in only a working space of about½ cm and then be expanded from about 100% to about 200%, typically about160%, of its original insertion size and locked in that position toprovide a closely controlled full range of permanent spinal correctionin three dimensions. These and other advantages of the invention willbecome more apparent from the following detailed description and theaccompanying exemplary drawings.

In other embodiments of the invention, extendable, locking, boneengaging anchors are provided to ensure that the implant is positivelyengaged with the bone after insertion.

In one implementation, the present disclosure is directed to a lockable,extendable spinal implant for placement between first and secondvertebral bodies. The implant includes: first and second bone engagingmembers each having a surface configured to respectively engage opposedfirst and second vertebral bodies; extension means acting between thefirst and second bone engaging members to control extension of the boneengaging members between contracted and extended configurations; firstand second fixed lock members fixed to one of the first and second boneengaging members and extending towards the opposite bone engagingmember, the fixed lock members being spaced apart and each having afixed locking surface; first and second moveable lock members capturedbetween the first and second bone engaging members for cooperation withthe fixed lock members, each moveable lock member having a moveablelocking surface configured to engage an opposed fixed locking surface onone the fixed lock member to prevent contraction of the extension means;a locking actuator configured to engage the moveable locking surfaceswith the fixed locking surfaces; and a link member operatively connectedbetween the first and second moveable lock members to coordinatemovement therebetween.

In another implementation, the present disclosure is directed to alockable, extendable spinal implant for placement between first andsecond vertebral bodies. The implant includes: first and second boneengaging members each having a surface configured to respectively engageopposed first and second vertebral bodies; first and second pistonsdisposed on one the bone engaging member and cooperating with matingcylinders disposed on the opposite bone engaging member, the pistonsmoveable between a contracted configuration within the cylinders and anextended configuration extending from the cylinders; first and secondarcuate, fixed lock members, each having a fixed locking surface,mounted to one of the bone engaging members, each disposed around onethe piston, the fixed lock members extending towards the opposite boneengaging member; first and second moveable lock members, each formedaround one the cylinder for cooperation with the fixed lock members,each moveable lock member having a moveable locking surface configuredto engage an opposed fixed locking surface on one the fixed lock memberto prevent contraction of the extension means; at least one biasingelement acting on at least one the moveable lock member to bias themember into engagement with its associated fixed lock member; and a linkmember operatively connected between the first and second moveable lockmembers to coordinate movement therebetween and force the other moveablelock member into engagement with its associated fixed lock.

In still another implementation, the present disclosure is directed to alockable, extendable spinal implant for placement between first andsecond vertebral bodies. The implant includes: first and second boneengaging members each having a surface configured to respectively engageopposed first and second vertebral bodies; first and second pistonsdisposed on one the bone engaging member and cooperating with matingcylinders disposed on the opposite bone engaging member, the pistonsmoveable between a contracted configuration within the cylinders and anextended configuration extending from the cylinders; first and secondarcuate, fixed lock members, each having a fixed locking surface,mounted to one of the bone engaging members, each disposed inside onethe piston, the fixed lock members extending towards the opposite boneengaging member; first and second moveable lock members, each formedinside one the cylinder for cooperation with the fixed lock members,each moveable lock member having a moveable locking surface configuredto engage an opposed fixed locking surface on one the fixed lock memberto prevent contraction of the extension means; at least one biasingelement acting on at least one the moveable lock member to bias themember into engagement with its associated fixed lock member; and a linkmember operatively connected between the first and second moveable lockmembers to coordinate movement therebetween and force the other moveablelock member into engagement with its associated fixed lock.

BRIEF DESCRIPTION OF THE DRAWINGS

For the purpose of illustrating the invention, the drawings show aspectsof one or more embodiments of the invention. However, it should beunderstood that the present invention is not limited to the precisearrangements and instrumentalities shown in the drawings, wherein:

FIG. 1 is a perspective view of an intervertebral implant in acontracted configuration embodying features of the invention.

FIG. 2 is a perspective view of the implant shown in FIG. 1 in anexpanded configuration.

FIG. 3 is an exploded perspective view of the implant shown in FIG. 1.

FIG. 4A is a top view of the implant shown in FIG. 1.

FIG. 4B is a side cross-sectional view through line 4B-4B of the implantshown in FIG. 4A.

FIG. 5A is a perspective view of a lower part of the implant shown inFIG. 1 with upper portions and bottom face removed.

FIG. 5B is a bottom view of the lower portion shown in FIG. 5A.

FIG. 6A is a perspective view of the upper portion of the implant shownin FIG. 1 with the lower portion removed.

FIG. 6B is an enlarged perspective view of the staircase-like lower locksupport shown in FIG. 3.

FIG. 7 is a partial side view of one of the locking mechanisms of theimplant shown in FIG. 2.

FIGS. 8A-9B are partial side views of the locking mechanism in FIG. 7shown in different expanded and locked configurations.

FIGS. 10A and 10B of the locking mechanism illustrate the expanded butunlocked configuration in FIG. 10A and the expanded and lockedconfiguration in FIG. 10B.

FIGS. 11A and 11B are perspective views of the lower lock support andspring locking actuator illustrating the operation thereof.

FIG. 11C is a perspective view of an alternative locking mechanism andlocking actuator embodying features of the invention.

FIGS. 12A-12C are perspective views of alternative lower lock supportdesigns embodying features of the invention.

FIGS. 13A-13B are perspective and side views respectively of analternative implant embodying features of the invention which has anarticulating top end plate.

FIG. 14A is an exploded perspective view of yet another alternativeimplant embodying features of the invention which has the lower locksupports within the extendable pistons.

FIG. 14B is a top view of the implant shown in FIG. 14A.

FIG. 14C is a side cross-sectional view through line 14C-14C of theimplant shown in FIG. 14B.

FIG. 15 is a perspective view of an alternative implant design havingfeatures of the invention wherein the locking mechanism surrounds acentral opening in the top end plate.

FIG. 16 is a perspective view of an alternative implant design havingfeatures of the invention wherein the expanding piston is centrallylocated and locking mechanisms are provided on both sides of theexpanding piston.

FIG. 17 is a simplified schematic illustration of an alternative implantdesign having ratchet and pawl locking members between the top andbottom plates of the implant.

FIG. 18 is a perspective view of an alternative implant design withratchet and pawl locking members between the top and bottom plates ofthe implant.

FIG. 19 is a cross-sectional perspective view of an implant design withratchet and cantilevered spring members between the top and bottomplates of the implant.

FIGS. 20A-20B, 21A-21B, 22-26, 27A-27B, and 28-29 schematicallyillustrate various means for locking an expanding member of implants inextended configurations embodying features of the invention.

FIG. 30 is a perspective view of yet another alternative implant designhaving features of the invention wherein the locking mechanism hasstraight upper and lower interfitting lock supports.

FIG. 31A-31G illustrate an alternative implant locking mechanism inwhich a wire-form surrounds a pair of upper support members with groovesconfigured to receive the wire-form.

FIGS. 32A and 32B are perspective views of a further alternativeembodiment of the present invention including locking, conical boneengaging anchors.

FIGS. 33A-C are perspective views showing alternative bone engaginganchors.

FIGS. 34A and 34B are perspective cross-sectional views of anotheralternative embodiment of the present invention including locking,screw-threaded bone engaging anchors.

FIGS. 35A and 35B are perspective views of yet another embodiment of thepresent invention including locking, telescoping bone engaging surfaces.

FIGS. 36A and 36B are cross-sectional views of another exemplaryembodiment of the present invention shown in a collapsed and an expandedconfiguration respectively.

FIG. 36C is a posterior perspective view of the embodiment in FIG. 36B,shown in an expanded state.

FIGS. 37A and 37B are end views of a lift mechanism according to afurther exemplary embodiment of the present invention, shown in acollapsed and an expanded configuration respectively.

FIGS. 38A and 38B are end views of a cross section of another embodimentof the present invention utilizing the lift mechanism shown in FIGS. 37Aand 37B, shown in a collapsed and an expanded configuration,respectively.

FIGS. 39A and 39B are top views of the respective embodiments shown inFIGS. 38A and 38B with the top plate removed.

FIG. 40 is an anterior perspective view of the embodiment shown in FIG.38B.

FIG. 41 is a posterior perspective view of still another exemplaryembodiment of the present invention, shown in an expanded configuration.

FIG. 42 is a perspective view of a lift mechanism of the embodiment ofFIG. 41.

FIGS. 43A and 43B are cross-sectional views of the embodiment of FIG. 41shown in a collapsed and an expanded configuration, respectively.

FIG. 44 is an exploded perspective view of another embodiment of thecurrent invention.

FIG. 45A is a partial inferior perspective of another embodiment of thepresent invention.

FIG. 45B is a partial top view of the embodiment shown in FIG. 45A.

FIG. 46A is an exploded perspective view of another embodiment of thecurrent invention.

FIGS. 46B and 46C are superior perspective views of the embodiment shownin FIG. 46A in the collapsed and expanded configurations respectively.

FIG. 47 is an exploded perspective view of another embodiment of thecurrent invention.

FIG. 48 is an exploded perspective view of another embodiment of thecurrent invention

FIG. 49 is an exploded perspective view of another embodiment of thecurrent invention.

FIG. 50A is a side view of an alternative implant design in a collapsedconfiguration having an articulating top plate.

FIG. 50B is a side view of the implant shown in FIG. 50A in an expandedconfiguration.

FIG. 50C is a top view of the implant shown in FIG. 50B.

FIG. 50D is a side cross-sectional through line 50D of the implant shownin FIG. 50C.

FIG. 51A is a side view of an alternative implant in a collapsedconfiguration having an articulating top plate.

FIG. 51B is a side view of the implant shown in FIG. 51A in an expandedconfiguration.

FIG. 52A is a side view of an alternative implant in a collapsedconfiguration embodying features of the invention which has twoseparated top plates.

FIG. 52B is a side view of the implant shown in FIG. 52A in a slightlyexpanded configuration.

FIG. 52C is a side view of the implant shown in FIG. 52B in a moreexpanded configuration.

FIG. 52D is a side view of the implant shown in FIG. 52C in a fullyexpanded configuration.

FIG. 52E is a top view of the implant shown in FIG. 52D.

FIG. 52F is a side cross-sectional through line 52F of the housing 111of the implant shown in FIG. 52E.

FIG. 53 is a side view of an alternative implant design in a fullyexpanded configuration having two separated top plates.

DETAILED DESCRIPTION

FIGS. 1-10B illustrate an example of an intervertebral implant 10, aSelectively Expandable Cage (SEC), having features of the invention. Theimplant 10 generally includes a housing 11, a housing base 12, aninterlocking top end plate 13, a bottom end plate 14, an interior cavity15 within the housing 11 and a pair of cylinders 16. The top and bottomend plates are the bone engaging members of the implant, providingsurfaces for engaging vertebrae above and below the implant when placedin the patient. Upper lock supports 17 are attached to the underside ofthe top end plate 13 thus forming fixed lock members and havemulti-stepped lower support surfaces 18 much like an inverted staircase.Lower lock supports 20, having multi-stepped upper support surfaces 21surround cylinders 16 much like an upright staircase. The multi-steppedsupport surfaces form the locking surfaces of the lock supports. Pistons22 are secured to the under surface of top end plate 13. Seal members 23are slidably disposed within the cylinders 16 and are mounted on pistons22. The upper surface 24 of bottom end plate 14 is provided with lockingactuator channels 25 which partially receive spring locking actuators26. The base 12 of the housing 11 has arcuate slots 27 which areconfigured to slidably receive the depending elements 28 or lockingactuator transfer element of the lower lock supports 20 and partiallyreceive the spring locking actuators 26. Depending elements 28 engagethe forward end 30 of spring locking actuators 26. The spring lockingactuators 26 are initially in a compressed configuration so that uponthe extension of the top end plate 13 and the attached upper locksupports 17, the lower lock supports 20 rotate about the cylinders 16due to the force applied by the biased spring locking actuator 26 thusforming moveable lock members. This causes the lock support surfaces 21of the lower lock supports 20 to engage support surfaces 18 of the upperlock supports so as to lock the top end plate 13 in an extendedconfiguration. The support surfaces 18 of the upper lock supports 17 andthe support surfaces 21 of the lower lock supports 20 are tiered withmultiple steps so that the implant 10 can be locked at several differentexpanded heights. The underside stepped support surfaces 18 of the upperlock support 17 may be provided with increasing riser height (alignmentfaces 46) in the upward direction to provide smaller incrementalexpansion near the end of the piston expansion. In addition oralternatively, the stepped support surfaces 21 of the lower lock support20 may be provided with decreasing riser height in the upward directionfor the same reason. A variety of riser heights of the upper locksupport 17 or lower lock support 20 can be provided. The lowermoststepped support surface 18 of the upper lock support 17 and theuppermost stepped support surface 21 of the lower lock support 20 may beprovided with various lengths and widths to ensure better support.

As can be seen in FIG. 2 there are two sets of upper lock supports 17attached to the top end plate 13 and there are two sets of lower locksupports 20 in this embodiment, but a single set or more than two setsof upper and lower lock supports can also be used to lock the implant 10in the expanded state. Also shown, for example, in FIG. 2 are cylinders16 and pistons 22, which provide one example of extension means inembodiments of the present invention. Other examples of extension meansare described herein below in connection with alternative embodiments ofthe invention.

The implant 10 is configured to be implanted between opposing vertebralbodies in the spine to facilitate bony fusion between those vertebralbodies. The implant 10 is shown in its collapsed or contractedconfiguration in FIG. 1 and in one example of its expanded configurationin FIG. 2. In the collapsed state, the implant 10 can be inserted easilyinto the intervertebral body space through a minimal incision and withminimal tissue removal. Once in that space, the implant 10 can beexpanded against the two opposing vertebral bodies to distract them andthereby restore height to the intervertebral space. This provides stableopposition of the implant 10 to both vertebral bodies and optimizes thebony fusion process. The fusion process can also be enhanced by fillingthe interior cavity 15 with autologous bone graft, a bone growthenabling matrix, and/or bone growth stimulating substances prior toand/or after insertion into the body.

Further details of individual parts of the implant 10 are depicted inFIGS. 3, 4A and 4B. Pistons 22 are attached to the underside of the topend plate 13 which are configured to support seal members 23 which runinside of cylinders 16 located in the housing 11. When the cylinders 16are pressurized as will be described in more detail below, the seals 23running inside the cylinders 16 and pistons 22 slidably disposed withinthe seals are vertically displaced, translating the top end plate 13vertically above the housing 11. Lower lock supports 20 are locatedaround the outer wall of the cylinders 16. When the top end plate 13 isvertically displaced, which in turn displaces the attached upper locksupports 17, the lower lock supports are rotated by the biased lockingactuators 26 to a locking position. Arcuate locking actuator channels 25in the top surface of bottom plate 14 and the arcuate slots 27 in thehousing base 12 confines the locking actuators 26 to the housing 11.

Additional details of the housing 11 are depicted in FIGS. 5A and 5B.The housing 11 comprises an outer wall 31 and cylinders 16 which aresecured to housing base 12. The outer wall 31 supports a leading nose 32on the distal end and a delivery boss 33 on the proximal end. Theleading nose 32 has inwardly directed side tapered faces 34 and toptapered face 35 and bottom tapered face 36. These tapered faces 34, 35and 36 enable non-traumatic insertion of the implant 10 past neuralelements and between the vertebral bodies. The delivery boss 33 containsa delivery tool anchor 37 which allows secure attachment of the implant10 to a delivery tool (not shown), which is illustrated in co-pendingapplication Ser. No. 11/535,432, filed Sep. 26, 2006, and Ser. No.11/692,800, filed Mar. 28, 2007 for insertion into a vertebral space.The delivery boss 33 also contains pressure input ports 38 which areused to deliver a pressurized fluid to the interiors of cylinders 16.The outer wall 31 of the housing 11 also provides side openings 40 whichprovide space for bony in-growth into central cavity 15 in the housing11 and provide radiolucent openings for the radiographic imaging of theprocess of bony in-growth. The housing base 12 also contains pressurechannels 41 which deliver pressurized fluid from the pressure inputports 38 to the interior of cylinders 16. Although the housing base 12of implant 10 is depicted with independent pressure channel 41 for eachcylinder 16, other embodiments can contain one or more branchingpressure channels for delivering pressurized fluid to two or morecylinders 16. As previously mentioned, the housing base 12 also haslocking actuator slots 27 which hold and guide the locking actuators 26.The locking actuator slots 27 contain a wider portion, locking actuatoropening 42, to enable insertion of the locking actuator 26 into thechannels defined by the locking actuator slots 27 in housing base 12 andthe locking actuator channels 25 in the bottom end plate 14. The housingbase 12 also has optional alignment bosses 19 which align the bottom endplate 14 to the housing 11 via optional alignment holes 9.

FIGS. 6A and 6B illustrate further details of the top end plate 13 andthe lower lock support 20. The two sets of pistons 22 and upper locksupports 17 are joined by connecting members or struts 44. The pistons22 have seal bosses 45 on which the seals 23 are mounted. The upper locksupports 17 have tiered lower support surfaces 18 and risers oralignment faces 46. The tiered or stepped support surfaces 18 of theupper lock supports 17 engage the stepped or tiered support surfaces 21of the lower lock supports 20. The alignment faces 46 of the upper locksupport are configured to engage the alignment faces 47 of the lowerlock supports 20. The uppermost support surface of the lower locksupport 20 has a lock support stop 50 which engages with the lower mostalignment faces 46 of the upper lock support to prevent the lower locksupport 20 from over rotating as it engages the upper lock support 17.The bottom of the lower lock support 20 also has the locking actuatortransfer element 28 which engages the forward end 30 of the springlocking actuator 26 to transfer the actuation force from the lockingactuator 26 to the lower lock support 20.

FIGS. 7 through 10B show details of the selectively expanding lockingsequence of implant 10 with the housing 11 removed. The collapsedconfiguration is shown in FIG. 7 with the support surfaces 18 of theupper lock support 17 resting on the support surfaces 21 of the lowerlock support 20. The locking actuator 26 is a biasing element, such as aspring, that engages the depending element or locking actuator transferelement 28 to urge the alignment faces of the lock supports in adirection where they contact. Thus, in one exemplary embodiment, thealignment faces 47 of the lower lock supports 20 are forced against thealignment faces 46 of the upper lock support 17. The lock support stops50 fit within the lower lock stop relief 52 (shown best in FIG. 6A) onthe top end plate 13. When the cylinders 16 are pressurized, the pistons22 raise the top end plate 13 and attached upper lock supports 17(straight arrow) moving the support surfaces 18 of the upper locksupport 17 off of the support surfaces 21 and moving the lower alignmentfaces 46 past the upper alignment faces 47. When the alignment faces 46of the upper lock support 17 have cleared the alignment faces 47 of thelower lock support 20, the locking actuators 26 (in this embodiment acompressed coiled spring) engaging the locking actuator transfer element28 force the lower lock supports 20 to rotate (curved arrow in FIGS. 8Band 9B). The support surfaces 21 of the rotating lower lock supports 20move to the next lower level of the support surfaces 18 of the raisedupper lock supports 17 until the alignment faces 47 of the lower locksupports 20 engage the next level of the alignment faces 46 of the upperlock supports 17. The lower lock support 20 and upper lock support 17then lock the top end plate 13 at this expanded level. This processrepeats itself at each locking level (FIGS. 8A, 8B, 9A, 9B and 10A)until the top level (or somewhere between) is reached as shown in FIG.10B. At this top level, the locking actuators 26 engage the lockingactuator transfer elements 28 and the lower lock supports 20 are rotatedso the lowermost alignment surface 46 of the upper lock support 17engages lock support stop 50 of the uppermost support surface 21 of thelower lock support 20. At this highest locked level only the lowestsupport surfaces 18 of the upper lock supports 17 and the highestsupport surfaces 21 are engaged providing all of the locking support. Ascan be seen from FIGS. 10A and 10B the lowest support surfaces 18 of theupper lock supports 17 and the highest support surfaces 21 of the lowerlock supports 20 can be wider than the other support faces to providesufficient support material when only these two faces are engaged.

FIGS. 11A and 11B illustrate the operation of locking actuator 26. Inthis embodiment the spring locking actuator 26 is compressed into an arcbeneath the lower lock support 20. One end of the spring lockingactuator 26 is constrained by the housing 11 (not shown) and the otheris engaged with the locking actuator transfer element 28. When the loweralignment faces 46 of the upper lock support 17 are raised above theupper alignment faces 47 of the lower lock support 20 by the extensionof piston 22, the locking actuator 26 pushes against the lockingactuator transfer element 28 and rotates the lower lock support 20 in aclockwise direction (arrow) as viewed from above. It should be notedthat in the embodiment of the current implant as described thus far, theangular orientation of the tiered upper and lower support surfaces 18and 21 can vary when there is more than one set of supports. As shown inFIG. 3 the proximal lower support surfaces 21 are oriented clockwise asviewed from above and the distal lower support surfaces 21 are orientedcounter-clockwise. This opposite orientation provides enhanced lockingsupport for rotational forces applied to the implant.

An alternative locking actuator 26 a is shown in FIG. 11C as a torsionspring. This locking actuator 26 a has constraining tab 53 secured tothe lower lock support 20 and constraining tab 54 secured to the housing11. Just as the compression spring shown in FIGS. 11A and 11B applies aforce to the lower lock support 20 to rotate it, the torsion spring inFIG. 11C does the same. An extension spring would work equally as wellas a locking actuator 26 a. Spring actuators can be made of anappropriate biocompatible material such as stainless steel, NITINOL,titanium or a suitable polymer. Locking actuators are not limited tosprings. A wide variety of mechanisms can be used to actuate the lowerlock supports 20, including but not limited to, a linear drive, anexternally actuated tensile member, a worm gear, an inflated member suchas a balloon or bellows, a magnet, a rotational drive such as a micromotor, a super elastic shape memory element, and the like.

FIGS. 12A through 12C show variations of the lower lock support 20described above. In FIG. 12A a tri-set lock support 20 a is shownwhereby there are three sets of upper support surfaces 21 a, upperalignment surfaces 47 a and lock support stops 50 a rather than the twosets described above. This tri-set lower lock support 20 a has twoadvantages over the two sets design, 1) there are three support columnsrather than two locking the implant 10 in an expanded state therebycreating a more stable lock and 2) the tri-set lower lock support 20 ahas to move or rotate much less for each locking level. This lastadvantage is significant when the locking actuator is a spring such asspring locking actuator 26 as this places less strain on the spring toachieve the required locking force at each step. Each lower lock supportcolumn will have a corresponding upper lock support column (not shown).The upper support surfaces 21 and lower support surfaces 18 are notlimited to two or three sets of surfaces. Any number of sets of supportsurfaces including a single set may be employed.

FIG. 12B shows an inter-digitating lower lock support 20 b. Each of theinter-digitating upper support surfaces 21 b on the inter-digitatinglock support 20 b is paired with an inter-digitating stop 50 b whichwhen paired with matching inter-digitating support surfaces and stops ofan upper lock support (not shown) prevents the inter-digitating supportsurfaces 21 b from moving relative to the inter-digitating supportsurfaces of an upper lock support to unlock the implant without theinter-digitating lower support faces first lifting above theinter-digitating stop 50 b. This design provides an enhanced lockingfeature. Upper alignment surfaces 47 b are again provided.

Generally the lower support surfaces 18 and the upper support surfaces21 are horizontal to maximize vertical support in the locked implant.However, the locking support 20 c shown in FIG. 12C provides an enhancedlocking feature by providing inclined support surfaces 21 c which have aslope relative to the horizontal which requires matching inclined lowersupport surfaces on the upper lock supports (not shown) to be liftedabove the inclined upper support surfaces 21 c before the upper locksupport can be rotated to unlock the implant.

FIGS. 12A and 12C show various lengths of locking actuator transferelements or depending elements 28. The locking actuator transfer element28 can vary in length depending on how much engagement is desiredbetween the locking actuator transfer element 28 and the lockingactuator slots 27. The locking actuator transfer element 28 includes oneor more transfer element tabs 29 a and 29 c which vertically constrainthe lower lock support 20 to the locking actuator slots 27 in thehousing 11. The wider locking actuator opening 42 described above (seeFIG. 5B) enables insertion of the locking actuator transfer element 28with transfer element tabs 29 a and 29 c into the locking actuator slots27 in housing base 12 at the rotational position where the lockingactuator transfer element 28 is aligned with the locking actuatoropening 42. In other rotational positions the transfer element tabs areconstrained by lateral extensions on the sides of the narrower lockingactuator slots 27. In this manner the locking actuator transfer element28 provides both the function of transferring force from the lockingactuator 26 to the lower lock support 20 as well as constraining thelower lock support 20 to the housing 11. This later function preventsthe frictional forces between the lower alignment faces 46 and the upperalignment faces 47 created by the biased spring locking actuator 26 fromlifting the lower lock support 20 along with the upper lock support 17when the upper lock support 17 is lifted by the piston 22.

As an alternative to the locking actuator transfer element 28, theembodiment shown in FIG. 12B depicts a locking actuator guide channel80. This locking actuator guide channel 80 engages a tensile member (notshown) which transfers actuation force from the locking actuator 26 tothe lower lock support 20. Tensile members can be any of a number ofknown elements such as sutures made of polymers or natural materials,metal cable, plastic or metal rod and the like.

FIGS. 13A and 13B illustrate an alternative design of an implant 110embodying features of the invention. The implant 110 has independentactuation of the distal piston 122 a and proximal piston 122 b. The twopistons 122 a and 122 b are interconnected by an articulating top endplate 113 which allows independent lift and locking of each side of theimplant 110. This independent lift and locking of both ends of theimplant 110 enables the implant to conform to intervertebralend platesthat have uneven lateral heights between them. Further, this independentlift and locking allows the implant 110 to be used to create varyinglateral heights between vertebralend plates which can be useful tocompensate for a scoliosis in the spine.

Implant 110 has a housing 111 which has an alternative delivery toolanchor 160 located in it as well as alternative pressure input ports137. A variety of anchor designs or pressure ports can be used with anyof the embodiments of the current device without departing from thescope of this invention. Lock and unlock access ports 138 are alsolocated on this housing 111. These ports are used to guide lock andunlock mechanisms (not shown) which can be manipulated externally to theimplant 110 to actuate the lower lock support 120 to not only move itunder the upper lock support 117 to hold the piston 122 b andarticulating end plate 113 in an expanded position, but also to move thelower lock support 120 away from the upper lock support 117 to allow thepiston 122 b and articulating end plate 113 to collapse back into thehousing 111. This later action may be desirable to remove the implant110 from or reposition the implant within the intervertebral space. Avariety of lock/unlock mechanisms can be used with the current inventionsuch as but not limited by, a tensile member including suture thread andmetallic cable, a compressive member such as a metallic or polymer rod,pressurized fluid, a rotating drive, a super elastic shape memoryelement, and the like.

FIGS. 14A-14C depict yet another alternative implant 210 that embodiesfeatures of the invention. Implant 210 has an interfacing top plate 213which connects to separate and freely rotating pistons 222 via thepiston capture plate 270 on the interfacing top plate 213 and the pistonheads 271 on the rotating pistons 222 ab. The rotating pistons 222 abalso interiorly contain upper lock supports 217 with support faces 218and alignment faces 246. Seals 223 are mounted on the rotating pistons222 ab and the seals 223 and rotating pistons 222 ab fit into internalcylinders 216 that are located on the housing 211. The internalcylinders 216 have lower lock supports 220 with support surfaces 221 andalignment faces 247 as well as lower retaining features 273. The housing211 also contains one or more pressure input ports 238.

In use, the implant 210 is inserted into the intervertebral body spacein a collapsed state and fluid pressure is delivered through thepressure input port(s) 238 to the internal cylinder(s) 216 to raise theseal(s) 223 and rotating piston(s) 222 ab out of the internalcylinder(s) thereby raising the interfacing top plate 213 and expandingthe implant 210. Once the rotating pistons 222 ab have been raised suchthat the lower alignment faces 246 of the upper lock supports 217 havecleared the upper alignment surfaces 247 of lower lock supports 220, anactuator (not shown) rotates the rotating pistons 222 ab such that thelower support surfaces 218 of the upper lock supports 217 are movedabove the upper support surfaces 221 of the lower lock supports 220, tothereby lock the implant 210 in the expanded configuration. The actuatorcan be one or more tensile members such as suture threads or cables thatextend from the user into the implant 210 through the lock and unlockaccess ports 238 on the interfacing top plate 213 to the piston head271. Applying tension to one or more tensile members when the piston isin an extended configuration will rotate the piston heads 271 such thatthe support surfaces 218 of upper lock supports 217 are moved above thesupport surfaces 221 of the lower lock supports 220 thereby locking theimplant 210. Alternatively or in addition to applying tension to lockthe implant 210 in an expanded configuration, applying tension to one ormore tensile members will rotate the piston heads 271 such that thelower support surfaces 218 are moved away from the upper supportsurfaces 221 thereby unlocking the implant 210 and allowing the rotatingpistons 222 ab to seat back into the internal cylinders 216 such thatthe implant 210 is once again in a collapsed configuration.

FIG. 15 illustrates an alternative implant design 310 embodying featuresof the invention which has a housing 311, top end plate 313 and pistons322 similar to the prior embodiments. This implant 310 has upper locksupports 317 and lower lock supports 320 within a central portion of theimplant. The upper lock supports 317 are secured to the top end plate313 and the lower lock supports 320 are secured to the base 314 withdepending elements (not shown) as was described above and are moved asin the prior embodiments.

FIG. 16 illustrates an alternative implant design 410 embodying featuresof the invention which has a housing 411, top end plate 413 and acentrally located piston 422 similar to the prior embodiments. Thisimplant 410 has upper lock supports 417 and lower lock supports 420distal and proximal to the centrally located cylinder 416 and piston422. The upper lock supports 417 are secured to the top end plate 413and the lower lock supports 420 are secured to the base 412 and aremoved as in the prior embodiments via depending elements (not shown) aswas described above.

FIG. 17 shows another alternative implant 510 which has a pair ofpistons 522 and which has a locking support system which includesratchets 521 on the base 512 and pawls 517 pivotally mounted to anddepending from the top end plate 513. Expansion of the pistons 522causes the free ends 518 of pawls 517 to engage recesses 520 in theratchets 521 so as to lock the top end plate 513 in an extendedconfiguration.

FIG. 18 illustrates another alternative implant design 610 which issimilar to that shown in FIG. 17. In this embodiment the free end of thepawl 617 has a plurality of teeth 618 to provide greater effectivecontact between the pawl 617 and the ratchet 621 for locking of theimplant 610.

FIG. 19 is a cross section embodiment, showing implant 710 embodyingfeatures of the invention. In this embodiment the pistons 722 aresurrounded by upper lock support 717 which has at least one cantileverextension ending at the support surface 718. The support surfaces 718are captured by the recessed support surfaces 721 which are located onthe inner wall of the housing 711. Once the pistons 722 are expanded inan upward direction, the support surfaces 718 of the upper lock support717 engages the recessed support surfaces 721 locking the implant 710 inplace. The upper lock support 717 can be rotated relative to the piston722 and housing 711 to disengage the support surfaces 718 from thesupport surfaces 721 to unlock the implant 710 and lower the pistons 722as needed. Alternatively the implant 710 can be unlocked by rotating theupper lock support constraints 775 relative to the upper lock support717 to press on the cantilever extensions and disengage the supportsurfaces 718 from the support surfaces 721.

FIGS. 20A-31 illustrate a variety of suitable means for lockingextendable members such as pistons in extended configurations. FIGS.20A, 20B, 21A, 21B, and 22-31 show variations of lower lock supports andupper lock supports. In each of these variations there are supportsurfaces on the lower lock supports which engage support surfaces on theupper lock supports.

In FIGS. 20A and 20B support surfaces 818 comprise grooves set into theupper lock support 817. The lower lock support 820 is a U-shaped tongwhich is configured to advance (as indicated by the arrow in FIG. 20A)towards the upper lock support 817 and to engage one of the grooves withits upper support surface 821 for locking an implant not shown in thesedrawings. Lower lock support 820 is withdrawn (as indicated by the arrowin FIG. 20B) from the groove to disengage the lower lock support andunlock the implant.

In the variation shown in FIG. 21A, the lower lock support 920 is aplate with an upper lock clearance opening 970 that is shaped to allowpassage of the cylindrical flat-sided upper lock support 917 through thelower lock support 920 (arrow). As shown in FIG. 21B, once the lowerlock support 920 is positioned at the desired location it can be rotatedapproximately 90° (arrow) to engage the support surfaces of the lowerlock support 920 with the support surfaces 918 of the upper lock support917. The shape of the upper lock support 917 and mating upper lockclearance opening 970 on the lower lock support 920 are not restrictedto the profile shown in FIGS. 21A and 21B nor is the locking actuationrestricted to 90° rotation of one of the elements but can vary to anynumber of shapes that allow passage in one configuration but constraintwhen one of the elements is moved to another configuration.

In FIG. 22, the upper lock support 1017 is a cylinder with notches cutto create support surfaces 1018. The lower lock support 1020 is apivoting pin 1070 with a pawl 1071 for the lower support surface 1021.In the configuration shown, the support surface is biased as indicatedby the arrow 1072 to allow the upper lock support 1017 to rise with anexpandable member of an implant and to prevent the upper lock supportfrom dropping. This allows the device to lock at each level when thesubsequent support surface 1018 of the upper lock support 1017 engagesthe support surface 1021 of the lower lock support 1020. In thisvariation having features of the present invention, the upper locksupport 1017 can also be lowered by moving the pivoting pin 1070 of thelower lock support 1020 away from the upper lock support 1017 todisengage the support surface 1021 from the support surface 1018.

FIG. 23 shows yet another embodiment having features of the inventionwhere the lower lock support 1120 is a pin configured to engage (arrow)support surfaces 1118 located in the upper lock support 1117. The lowerlock support 1120 does not have to engage the full thickness of theupper lock support 1117 as shown in this figure, nor does the supportsurface 1118 have to extend through the entire thickness of the upperlock support 1117 but rather can engage any portion of the upper locksupport 1117 that is sufficient to lock an implant in position. Thisembodiment also allows a variety of shapes of pins 1120 and matchingsupport surfaces 1118.

In FIG. 24 the lower lock support 1220 is a grip with two pivoting jaws1270, the ends of which have support surfaces 1221. The upper locksupport 1217 has a series of notches which have the support surfaces1218. A lock actuator such as a compressive spring (not shown) can applyforce (as shown by the arrows 1272) to the grip base extensions 1273 tolock the device. This variation having features of the invention allowsthe upper lock support 1217 to move upwards but prevents downward motionthereof. Downward motion of the upper lock support 1217 can be allowedby reversing the force on grip base extensions 1273.

Not all locking systems embodying features of the invention require theengagement of support surfaces of the upper lock supports directly ontop of the support surfaces of the lower lock supports. A frictionalsupport can be created to lock the device as shown in FIGS. 25 through32.

In FIG. 25 the upper lock support 1317 has one or more flat surfaces asthe support surfaces 1318. The lower lock support 1320 has one or morepivoting pawls that have a support surface 1321 that engage the supportsurface 1318 and supports a load (arrow).

In FIG. 26 the upper lock support 1417 has an exterior support face 1418which is gripped by the support face 1421 on the inner diameter of thewrapped lower lock support 1420. This lower lock support 1420 can be atorsion spring that in its free state grips the upper lock support 1417and releases the upper lock support when a force (arrows) is applied toone or more of its ends 1470 as shown to increase the spring's innerdiameter. The reverse is possible where in its free state the lower locksupport 1420 allows movement of the upper lock support 1417 inside theinner diameter. When a tensile force is applied to the ends 1470 toreduce the inner diameter, the lower lock support grips the supportsurface 1418 of the upper lock support 1417 to lock the implant.

FIGS. 27A and 27B show another variation which can be described as acanted washer type device. The lower lock support 1520 is a plate withan upper lock clearance opening 1570 which allows relative movement ofthe upper lock support 1517 as shown in FIG. 27A. When the lower locksupport 1520 is canted as shown in FIG. 28B, the edge of the upper lockclearance opening 1570 comprises a lower support surface 1521 whichengages the upper support surface 1518 which is the outer surface of theupper lock support 1517 locking it relative to the lower lock support1520.

Yet another variation of the gripping lock of the current invention isshown in FIG. 28. In this variation the lower lock support 1620comprises one or more jaws which have support surfaces 1621 that areconfigured to be forced against the support surface 1618 of the upperlock support 1617 to produce friction to lock the device in place.

FIG. 29 illustrates a lower lock support 1720 which comprises a pivotand pawl as has been detailed above. The end of the pawl comprises alower support surface 1721 which engages an upper support surface 1718on the upper lock support 1717. In this embodiment the upper locksupport 1717 is rotated counter clockwise by an expanding element (notshown). This rotation in turn raises the piston 1722 which expands theimplant. In this manner the upper lock support 1717 is integrated intothe lifting mechanism to engage the lower lock support 1720 and lock theimplant as it expands.

FIG. 30 illustrates yet another alternative implant 1810, similar tothat shown in FIG. 1 except that the upper locking member 1817 and lowerlocking member 1818 have a linear shape rather than the arcuate shape ofthe prior embodiments. The implant 1810 generally has a housing 1811, atop plate 1813, a bottom plate 1814, pistons 1822 and cylinders 1816.The upper locking member 1817 has support surfaces 1818 and the lowerlocking member 1820 has support surfaces 1821. The implant 1810 has alocking actuator (not shown).

FIGS. 31A-31G illustrate another implant 1910 embodying features of theinvention which have upper locking members 1917 with grooves 1970 havingsupport surfaces 1918 and lower locking member 1920 with lockingsurfaces 1921. The lower locking member 1920 is a wire-form whichencircles the exterior of both upper locking members 1917 and isconfigured to seat within the grooves 1970. Expansion of the lowerlocking member 1920 (arrows in FIG. 31B) by the locking actuator (notshown) causes the lower locking member 1920 to be pulled out of thegroove 1970 and allows the upper locking member 1917 to rise with theexpansion of the implant. Release of this expansion of the lower lockingmember 1920 (arrows in FIG. 31A) allows the lower locking member 1920 toseat back into the groove 1970 locking the implant 1910.

FIG. 31G illustrates a detail of an alternative implant 1910 a embodyingfeatures of the invention which have upper locking members 1917 a withgrooves 1970 a having support surfaces 1918 a and lower locking member1920 a with locking surfaces 1921 a. The lower locking member 1920 a isa wire-form which encircles the exterior of both upper locking members1917 a and is configured to seat within the grooves 1970 a. The supportsurface 1918 a locks on the support surface 1921 a when there is acompressive or downward force (hollow arrow) on the upper locking member1917 a locking the implant 1910 a. Upward force or extension (solidarrow) of the upper locking member 1917 a causes the lower lockingmember 1920 a to ride on the disengaging surface 1919 a and out of thegroove 1970 a allowing the upper locking member 1917 a to rise with theexpansion of the implant 1910 a.

In a further aspect of the present invention, a piston/cylinder andlocking arrangement as described above may be used to deploy extendablebone anchors. For example, implant 10A with conical bone engaginganchors 60 as shown in FIGS. 32A and 32B may be constructed with pistons22 and cylinders 16 as described above in connection with implant 10 andshown, for example, in FIGS. 2, 3 and 4B. Implant 10A has a housing 11as previously described and may include other previously describedfeatures such as interior cavity 15 for bone growth stimulatingsubstances. However, in this embodiment, instead of upper interlockingend plate 13, the two pistons 22 individually terminate with conicalbone engaging anchors 60. The bone engaging anchors, including sharpleading tip 62, form surface for engaging the vertebral body.

As shown in FIG. 32A, bone engaging anchors 60 are in a contractedconfiguration, within housing 11, to facilitate insertion of implant10A. Using hydraulic actuation as previously described, bone engaginganchors 60 are moved to an extended configuration as shown in FIG. 32B,wherein at least leading tip 62 extends beyond housing 11 to engage andanchor in the bone. In order to ensure that the bone engaging anchorsremain firmly engaged in the bone, locking mechanisms includingmulti-stepped upper and lower lock supports 17, 20 as previouslydescribed in connection with implant 10 and shown, e.g. in FIGS. 6A-12C,are provided to support each anchor 60 in the extended configuration.With this arrangement, the extended and locked anchor 60 helps to retainthe implant in place.

A variety of alternatives are possible for the bone engaging anchoraccording to the invention as illustrated in FIGS. 33A-C. For example,implant 10B in FIG. 33A includes bone engaging anchors formed as spike60A and blade 60B. Blade 60B can be particularly effective in preventingmotion along the insertion path after deployment. In this case, thelength of the blade 60B is aligned in the direction shown by arrow A.This is substantially orthogonal to the direction of implantation (arrowB) and would resist movement in that direction. Implant 10F, shown inFIG. 33B includes further possible variations. In this embodiment, thebone engaging anchors are formed as barbed spikes 60C. Barbs 61 alongthe shaft of the spikes resist forces that tend to move the tissue awayfrom the implant along the axis of the anchor (much as the screwthreaded anchor described below would also resist this force). Alsoincluded in implant 10F is a lateral bone engaging anchor 63 foranchoring in laterally oriented tissue. In the illustrated embodiment,lateral anchor 63 includes a plain spike 60A. Lateral anchor 63 isformed in the same manner and with the same components, i.e. piston,cylinder, locking mechanism, etc. as elsewhere described in thisapplication, except that the components are oriented laterally as shown.To provide support for the bone anchor components in this lateralembodiment, housing 11 includes a central member 11A that dividesinterior cavity 15 into two portions. In the configurations of implants10B and 10F, the top of piston 22 can also become a bone engagingsurface when the anchor member is fully received within the bone. FIG.33C shows a further alternative implant 10G, including anchors 65extending obliquely from housing 11, rather than orthogonally. Thisoblique arrangement is helpful in resisting side to side rotationalforces (for example when the patient/spine bends towards the side) andexpansion forces. Once again, obliquely extending anchors 65 areessentially identical to other bone engaging anchors described hereinexcept for the oblique orientation. Here, holes 68 are provided in topend plate 66 for the spikes to pass through. In general, bone engaginganchors according to embodiments of the invention should have arelatively small termination (e.g. tip 62) relative to the size of thepiston diameter so that the force on the piston created by the hydraulicfluid is proportionally a much greater force at the small anchortermination to enhance its ability to extend into hard bony tissues. Itwill also be appreciated by persons skilled in the art that the variousfeatures of the bone engaging elements, e.g. spike, blade, barbs, etc.,described herein may be combined in any desired combination, in additionto the exemplary combinations shown in the figures of the presentapplication.

In another alternative embodiment, illustrated in FIGS. 34A and 34B,implant 10C includes screw-threaded members 64 as bone engaging anchors.Implant 10C also illustrates a further alternative wherein the boneengaging surfaces, such as the anchors, extend from opposite sides ofthe implant. In this exemplary embodiment, interlocking end plate 13 isreplaced with an integrated top end plate 66. Holes 68 are provided forthreaded member 64 to pass through. Persons of ordinary skill in the artwill appreciate that holes 68 will be located as needed; in theillustrated embodiment one is in top end plate 66 and the other inbottom end plate 14.

Threaded members 64, as bone engaging anchors extend outwardly frompistons 22. In order to rotate the threaded anchors into the bone whenthe pistons are extended, the inner wall of housing 11 is provided witha screw-threaded surface 70 that mates with corresponding threads 71cooperating with pistons 22. As previously described, seals 23 actbetween the pistons 22 and cylinders 16 to prevent leakage of hydraulicfluid. When fluid is pressurized within the cylinders as described forprior embodiments, the piston is extended, but also driven in a circularmotion by the engagement between threaded surfaces 70 and 71. Thescrew-threaded member 64 is thus driven into adjacent bone as it isextended to anchor the implant.

Once again, locking mechanisms as previously described and shown, forexample, in FIGS. 6A-12C, may be employed to prevent the bone engaginganchors from becoming unengaged from the bone. In the cross-sectionalviews of FIGS. 34A and 34B, upper and lower lock supports 17, 20 arevisible around the outside of the piston and cylinders. Alternatively,depending on the depth and pitch of the threaded portions, use of aseparate locking mechanism may not be required. As persons of ordinaryskill will appreciate, the configuration of the threads alone may besufficient to prevent the anchors from backing out.

FIGS. 35A and 35B illustrate a further aspect of the present inventionwherein locking mechanisms as described are utilized to securetelescoping bone engaging surfaces in place. As used herein, telescopingrefers to nested, extendable members including at least one intermediatemember between a base and bone engaging member.

Referring first to FIG. 35A, implant 10D has substantially planar boneengaging members 72. Bone engaging members 72 are thus similar to thebone engaging members of implant 10, but instead individually actuatedwithout interlocking end plate 13. The piston/cylinder arrangement isalso similar to that previously described except that here upper piston74 is received in intermediate piston 80. Intermediate piston is in turnreceived in cylinder 16 as was previously described for piston 22. Upperpiston 74 is sealed against intermediate cylinder 78 of intermediatepiston by upper piston seals 76 (see FIG. 35B).

The telescoping bone engaging members 72 are secured by lockingmechanisms in a similar manner to the earlier described embodiments,with the addition of an upper lock support 82 for the upper piston.Intermediate piston 80 is supported by upper lock support 17 and lowerlock support 20 as previously described. Upper lock support 82 includesupper and lower lock supports 84, 86. Thus, upper piston 74 is securedto upper lock support 84 of the upper lock set. Lower lock support 86 ofthe upper lock set is mounted on top of upper lock support 20 of thelower lock set. One difference from the earlier described embodiments isthat separate spring actuators 26 are not required for the upper lockset as they may be rotated along with the lower lock set by actuators26.

Implant 10E, as shown in FIG. 35B includes a further variation in whichthe planar portion of upper bone engaging surface 88 is effectivelyannular with a conical anchor 90 at the center. Advantages ofembodiments of the present invention including bone engaging anchorsinclude the ability of the anchors to be extended lateral from the longaxis of the implant (i.e., the insertion axis) with a relatively highforce using the relatively small connection to the implant of thehydraulic line. This is an advantage over other methods that requirelarger access or larger connections to the implant for lager tools ornon-hydraulic extension forces to extend the anchors into the hard, bonytissue.

Although the previously described embodiments of the invention includedcylinders 16 and pistons 22 expanded with a pressurized fluid as themechanism used to lift the top end plate away from the bottom end plate,embodiments of the present invention are not limited to only such liftmechanisms. In FIGS. 36A-C an alternative embodiment of the presentinvention comprising implant 10F is shown wherein a pair of bellows 92replaces the piston and cylinder pairs previously described. One end ofbellows 92 is attached to housing 11 and the other end to top end plate13. A pressurized fluid added via pressure input ports 38 is directedthrough bellows orifice 94 into the inside of bellows 92 causing thebellows to expand. The expanding bellows forces top end plate 13 awayfrom housing 11 and lower lock supports 20 are rotated to lock thedevice in the expanded configuration as was previously described.Bellows 92 can be made of any biocompatible material such as the 316series of stainless steels, titanium or a titanium alloy, a cobaltchromium alloy, or an implantable polymeric material. The bellows can beof an accordion-like folding configuration as shown in FIGS. 36A-C orany other regular or irregular configuration which can fit inside of thehousing and lock supports in the collapsed configuration and expandsufficiently when pressurized to lift top end plate 13 the desiredamount away from housing 11. Lower lock supports 20 and upper locksupports 17 provide a confining geometry for bellows 92, which allowsuse of an irregular bellows configuration. With a bellows arrangement asshown in FIGS. 36A and 36B, the amount of lift is not limited as is thecase in a cylinder and piston to the amount that the collapsed cylinderand piston overlap.

Other exemplary embodiments do not rely on the use of a pressurizedfluid for expansion. For example, FIGS. 37A and 37B show an alternativerotating cam lift mechanism 93. Cam lift mechanism 93 includes cam 96with a substantially curved cam surface 95 and a substantially flat topsurface 97, rotating shaft 98, and shaft supports 99. Cam 96 is attachedto rotating shaft 98, and shaft 98 is supported by and rotates withinshaft supports 99. In an implant 10G (FIG. 40) using this mechanism, theshaft supports 99 are anchored to the inside of housing 11 and rotationof shaft 98 (depicted by curved arrows) rotates the curved cam surface95 against the bottom of top end plate 13 and moves top end plate 13away from housing 11 as shown in FIGS. 38A-38B, 39A-39B and 40. Theshape of cam 96 determines both the amount of lift that is possible andthe relative amount of lift to the amount of rotation of the cam. Thecam is not limited by 90 degrees of rotation depicted in the figures.Any shape of a cam that is rotated by any amount from as little as 10degrees to as much as 355 degrees is possible without departing from thescope of the present invention. Shaft rotation can be accomplished byseveral means as will be discussed in more detail below. Use of cam liftmechanism 93 as the lifting mechanism along with lower and upper lockingsupports 20 and 17 for implant 10G allows the lift mechanism to supportonly the initial lifting loads and not have to support the repetitivelong-term supporting loads on implant 10G which are borne by the lockingsupports. Cam 96 does not require a substantially flat top surface 97 asshown in the exemplary embodiment to support top end plate 13, but sucha surface provides a rotational endpoint for the surgeon rotating shaft98.

Another alternative embodiment is implant 10H shown in FIGS. 41, 43A and43B. Implant 10H uses a rotating screw lift mechanism 193 as shown inFIG. 42. This mechanism includes shaft 98, shaft supports 99, worm gears170 attached to shaft 98 and a shaft input end 178 at one end of shaft98. The mechanism also includes lift screws 172, which have lower liftthreads 174 and transfer gear 176 and supporting boss 186. Applying atorque via shaft input end 178 turns shaft 98, which turns the attachedworm gears 170. Worm gears 170 turn transfer gear 176 on lift screw 172.Lift screw 172 is contained within housing 11 by way of its supportingboss 186, which is seated in housing bearing 188. Rotation of lift screw172 transfers force from lower lift threads 174 to upper lift threads182 on upper lift nut 180. Upper lift nut 180 is attached to top endplate 13 so that rotation of shaft input end 178 lifts upper end plate13 away from housing 11. The relative pitch of worm gears 170 andmatching transfer gears 176 and the lower lift threads 174 and matchingupper lift threads 182 can be varied to achieve the desired amount oflift relative to the amount of rotation and torque. The torque can beapplied by any means well known by those skilled in the art includingbut not limited to electric motor, pneumatic or hydraulic turbine, ormanual rotation of an actuator. Shaft input end 178 is shown as ahexagonal post, but any alternative input end can be used withoutdeparting from the scope of the present invention, such as, but notlimited to, a square or star-shaped post, a square, star orhexagonal-shaped socket, or a keyed shaft.

As shown in FIG. 44, an alternative embodiment of the implant 10Iincludes a linking element 202 that connects the lower lock supports 20Aand 20B. The linking element 202 coordinates the action of the lowerlock supports 20A and 20B. When the locking actuator 26 actuates theleading lower lock support 20A, the linking element 202 in turn actuatesthe following lower lock support 20B. In this embodiment the implant 10Imay require only a single locking actuator 26, however plural lockingactuators as described above (see, for example, FIG. 3) may be employedfor greater actuation force as needed. In addition to actuating thefollowing lower lock support 20B, the linking element 202 prevents theleading lower lock support 20A from actuating until the alignment faces46 of both the leading upper lock supports 17A and the following upperlock supports 17B each clear the alignment faces 47 of both the leadinglower lock support 20A and the following lock support 20B. In thismanner the linking element 202 ensures the coordinated actuation of thelower lock supports 20A and 20B to ensure that the implant 10I willalways lock at the same height on both sides. This can be advantageousfor certain implants placed in the spine where an even expansion of theimplant is desired.

Linking plural lower lock supports, such as supports 20A and 20B, with alinking element 202 for even expansion in the manner described may beadvantageous over an implant with a similarly sized single lock support20, and single cylinder 16 and piston 22 due to the increase in thenumber of support elements, the broader support base, and the increasein expansion force due to the increased number of cylinder and pistonpairs. Increasing the size of a single lock support would still havedisadvantages of a larger width that would limit the ability forimplantation in minimally invasive surgery. Embodiments of the inventionare not limited to just the pair of lower locking supports 20A and 20Bas shown in, for example, FIG. 33. Rather, any number of sets ofcylinders 16, pistons 22, upper lock supports 17, and lower locksupports 20, with a locking actuator 26 and the appropriate number oflinking elements 202 are possible.

For the embodiment illustrated in FIG. 44, linking element 202 isconfigured to fit inside attachment grooves 204 on the lower locksupport 20A, B. Alternatively, linking element 202 may be configured torest on the outside diameter of the lower lock support 20A, B. Thelinking element 202 can also be configured to run underneath the lowerlock supports 20A, B as shown in FIGS. 45A-D. For implant 10I in FIG. 44both of the lower lock supports 20A and 20B rotate in the same directionwhen actuated. Elements of an alternative implant shown in FIGS. 45A-Binclude lower lock supports 20 that actuate with rotation in oppositedirections. The linking element 202 is guided between the lower locksupports 20 through a link channel 210 in housing 11 (FIG. 45B). Thelinking element 202 is constrained in the link channel 210 by a channelcover 208. The linking element 202 is connected to the lower locksupports 20 by means of link pins 206.

The linking element can be made from any of a variety of implantablematerials including: a titanium wire, a titanium cable, a stainlesssteel wire or cable, a nitinol wire, a braided or mono-filament suturefrom any manner of suture material such as silk, polyester,polypropolyene, ePTFE, or UHWPE. An implantable material that has atensile strength sufficient to transfer the actuation force from theleading lower lock support 20A to the following lower lock support 20Bas well as flexibility sufficient to follow the link channel 210 and/orrotate around the lock supports 20 may be used. Linking element 202 canbe attached to the lower lock supports 20 in a number of ways known tothose practiced in the art, the selection of which depends on factorssuch as the linking element material and the lower lock supportmaterial. Suitable techniques include laser welding, resistance welding,adhesive bonding, crimping, attaching with clamps, pins, or screws, orbeing threaded through an opening and securing with a knot.

Turning now to FIGS. 46A, B and C an implant 10J with an additionalfeature, an unlocking tether 212 is shown. Unlocking tether 212 isattached to the following lower lock support 20B in attachment groove204. Unlocking tether 212 is attached in the opposite direction as thelinking element 202 and can be attached in any of the ways describedabove for attaching the link element 202. The proximal end 214 of theunlocking tether 212 exits the housing 11 of the implant 10J through theunlock port 216. The proximal end 214 can be actuated by an externalforce or mechanism (not shown). Actuation of the proximal end 214 of theunlocking tether 212 to translate it away from the implant 10J causesrotation of the following lower lock support 20B, which will tension andtranslate the linking element 202 which will rotate the leading lowerlock support 20A. In this manner the unlocking tether 212 can be used tounlock the implant 10J so that it can collapse to a lower or to itsoriginal height. In FIG. 46B the implant 10J is collapsed and theunlocking tether 212 is extended a maximum distance out of the unlockport 216. FIG. 46C shows the same implant 10J with the top plate 13fully expanded above the housing 11 and locked. The unlocking tether 212has shortened as it was drawn into the implant 10J as the lower locksupports 20 rotated into locking position. Tensioning or pulling on theunlocking tether 212 will unlock the lower lock supports 20 and allowthe top plate 13 to collapse back into the housing 11. The ability tounlock and collapse the implant 10J can be highly advantageous to aphysician placing the device if there is a need to reposition or replacethe device after it has been expanded in-vivo.

Turning now to FIG. 47, another embodiment of an implant 10K is shownwith lower lock supports 20 that are located inside the cylinders 16 ofthe housing 11. In this embodiment the linking element 202 is a solidbar that can transfer compressive as well as tensile loads. The lockingactuator 26 rotates the leading lower lock support 20A, which pushes onthe linking element 202. The linking element 202 in turn pushes androtates the following lower lock support 20B. The lower lock supports20A and 20B engage the upper lock supports 17 that are located insidethe pistons 22 (shown in FIG. 14C). The rotation of the following lowerlock support 20B pulls the unlocking tether 212 into the housing 11through the unlocking port 38. The unlocking tether 212 can be tensionedaway from the housing 11 to reverse the process and unlock the implant10K.

The use of tension and compression elements as described above are notthe only means for coordinating the controlled locking and unlocking ofthe device. In FIG. 48 an alternative embodiment of the implant 10L isshown wherein thread gears 226A and 226B are used to both lock andunlock the lower lock supports 20 thus forming a combined linking andunlocking element. Threaded gears 226A and 226B are mounted on a shaft224 that is contained in the base of the housing. The proximal end ofshaft 224 has a keyed head 228 that can protrude from or rest in thelocking port 222. An external tool (not shown) can interface with thekeyed head 228 to rotate it in either direction. Rotating the keyed head228 will in turn rotate the shaft 224 and the threaded gears 226A and226B. The threaded gears 226A and 226B transfer the force to the lowerlock supports 20 through the geared bottom face 220. In the embodimentshown in FIG. 48 the threaded gear 226A is oriented opposite of thethreaded gear 226B. This allows rotation of the shaft 224 to rotate thelower lock supports 20 in opposite directions relative to each other. Itis obvious to those schooled in the art that the threaded gears 226A and226B can be oriented in the same direction if it is desired to rotatethe lower lock supports 20 in the same direction. In either case theshaft 224 can be rotated in one direction to rotate the lower locksupports 20 in the locking direction, and the shaft 224 can be rotatedin the opposite direction to rotate the lower lock supports 20 in theunlocking direction.

An unlocking tether as described herein can be engaged and tensioned byany number of means including but not limited to gripping the unlockingtether between articulating grips, a collet or split ring clamp,crimping the unlocking tether to a tensioning wire or rod and cuttingthe unlocking tether to disengage after use, mounting a magnet on theproximal end 214 (FIG. 46A) of the unlocking tether and engaging themagnet with a mating magnet attached to a tensioning wire of rod, addinga female or male thread to the proximal end 214 or the unlocking tetherand engaging it with a mating thread on the end of a tensioning rod orwire, or providing a continuous unlocking tether all the way to thepoint external to the body for tensioning and then cutting the unlockingtether near the implant after use to disengage. It is obvious to thoseschooled in the art that the unlocking tether can alternatively bepushed or compressed rather than tensioned as long as it is configuredto rotate the lower lock supports 20A and B in the unlock direction anddeliver sufficient load without buckling when pushed.

FIG. 49 illustrates an alternative embodiment of an implant 10M with apushable unlocking tether 212 a. In this embodiment, unlocking tether212 a engages the proximal lower lock support 20B to rotate it in theunlock direction when the unlocking tether 212 a is advanced towards theproximal lower lock support 20B. The link 202 transfers that rotationfrom the following lower lock support 20B to the leading lower locksupport 20A. The link 202 contains engagement pins 230, which extendinto receiving slots 232 on the lower lock supports 20A and 20B in orderto transfer the lateral movement of the link 202 into rotation of thelower lock supports 20A and 20B. In much the same way, the unlockingtether 212 can contain an engaging pin (not shown) to extend into areceiving slot (not shown) on the following lower lock support 20B totransfer the lateral compressive force applied to the unlocking tether212 a into rotation of the lower lock supports 20B. This is just onemethod for attaching or engaging the unlocking tether 212 to the lowerlock support 20 the numerous methods previously described herein forattaching or engaging the link 202 to the lower lock supports 20 can beused for attaching or engaging the tether 212 as well.

One advantage to pushing the unlocking tether 212 a to unlock theimplant 10M is that the method for engaging the unlocking tether issimplified. Unlocking tether 212 a, which is pushed to unlock theimplant 10M can be contained within the implant 10M and a push rod (notshown) can be easily directed into the implant 10M through the unlockport 216 to actuate the unlocking tether 212 a and unlock the implant10M such that it can collapse. This eliminates the need to attach to theunlocking tether 212 a which is required when the unlocking tether 212 ais tensioned to unlock the implant 10M.

FIGS. 50A-D illustrate an alternate embodiment of the implant 10Nembodying features of the invention. Similar to the implant 110 as shownin FIGS. 13A and 13B, the top end plate 113 of the implant 10Narticulates relative to the distal piston 122A and proximal piston 122B.The ends of the articulating top plate 113 have spherical projections2001A and 20001B which are contained within mating pockets 2002A and2002B in the two pistons 122A and 122 b. Split rings 2006A and 2006B areplaced over the spherical projections 2001A and 20001B and into thepistons 122A and 122B to vertically constrain the articulating top plate113 to the pistons. This geometry provides articulation of the top plate113 along not only the long axis (the axis extending along the line 50Cin FIG. 50C), as with the implant 110 shown in FIGS. 13A-B, but alsoprovides articulation in a side-to-side direction, which is an advantagefor providing congruence of the implant to the intervertebral space.Thus, the articulating top plate 113 is polyaxially movably coupled tothe pistons 122A and 122B, allowing the plate 113 to articulate about atleast two axes.

Also shown in FIG. 50D are vertical constraints 2003A and 2003B whichare attached to the distal piston 122A and proximal piston 122B. Thesetwo constraints 2003A and 2003B fit inside channels 2004A and 2004B inthe housing 111. The top portion of the channels 2004A and 2004B have anarrowed portion 2005A and 2005B that prevent the vertical constraints2003A and 2003B from advancing out of the housing 111. In this mannerthese vertical constraints 2003A and 2003B limit the maximum verticalmovement of the pistons 122A and 122B relative to the housing 111.

FIGS. 51A-B illustrate another alternative embodiment. FIGS. 51A-Billustrate an implant 10P that can have features similar to features inthe embodiments illustrated in FIGS. 13A, 14A-C, and 49. The implant 10Phas the articulating top plate 113 similar to that shown in FIG. 13Awhich pivots relative to the distal piston 122A and proximal piston 122Babout a distal pivot pin 2101A and a proximal pivot pin 2101B. Theimplant 10P has a distal piston 122A and a proximal piston 122B. As withthe pistons 222 a and 222 b shown in FIGS. 14A-C, the pistons 122A and122B can have internal upper lock supports 217. Unlike implant 210, inthe illustrated embodiment, the pistons 122A and 122B do not rotaterelative to the housing 111 as is the case in the implant 210. Instead,lower lock supports 20A and 20B similar to those shown in FIG. 49 rotaterelative to the housing 111 and the two pistons 122A and 122B to lockthe height of the expanded implant. In this manner, benefits of severalof the previously described embodiments are combined to provide andimplant 10P that can lock at different distal and proximal heights.

FIGS. 52A-F illustrate an alternative embodiment of the presentinvention, exemplified by implant 10R. In this embodiment, implant 10Rcan include a distal piston top plate 2222 that can be completelyseparate from a proximal piston top plate 2223. As shown in FIGS. 52B-D,the two piston top plates 2222 and 2223 can each expand to differentheights relative to the housing 111. Thus, the independently adjustabletop plates and their respective pistons provide a simple construct thatcan achieve variable expansion similar to the articulating top plate 113in implants 10N and 10P.

In some embodiments, the extendable members, such as pistons 122A and122B, may be actuated by a common actuator such as a single syringe orother pressurized fluid source but constrained as described herein torise to independent/different heights. Such constraint may be providedby specific constraint means as described, by a common top plate such asshown in FIG. 50D or a combination thereof.

As shown in FIG. 52F, the implant 10R can include a proximal lower locksupport 20B that can have stepped support surfaces that have shorterincrements than the stepped support surfaces on a distal lower locksupport 20A. The mating stepped support surfaces on the proximal upperlock support (not shown) in the proximal piston 122B can also haveshorter increments than the stepped support surfaces on the upper locksupport in the distal piston 122A. This variation in stepped supportsurface can be designed to produce a specifically desired expandedheight difference between the expanded distal piston top plate 2222 andthe expanded proximal piston top plate 2223. In addition, the expandedheight difference can vary with the amount of expansion. This variationcan be valuable, for example, for creating lordotic congruence betweenthe implant 10R and the vertebral bodies as the amount of lordosisrequired for proper congruence and spinal foraminal opening can increasealong with the increase in distance between the vertebral bodies.

The implant 10R can also have vertical constraints 2005A and 2005B whichcan be attached to the housing 111. In the illustrated embodiment, thevertical constraints 2005A and 2005B can prevent wide portions 2003A and2003B of the distal piston 122A and proximal piston 122B from advancingout of the housing 111. In this manner, these vertical constraints 2005Aand 2005B can limit the maximum vertical movement of the pistons 2222and 2223 relative to the housing 111.

FIG. 53 illustrates yet another alternative embodiment. As shown in FIG.53, an implant 10S can have a distal piston 122A that can have both ahorizontal vertebral engagement surface 2240 and an angled vertebralengagement surface 2242, such that the distal piston 122A can have avariation in vertebral engagement surface angles. These variations invertebral engagement surface angles can be beneficial for providing evenbetter congruence between the implant 10S and the vertebral bodies whena lordotic or variable height expansion is desired. The implant 10S canalso have a proximal piston 122B with a higher horizontal vertebralengagement surface 2244 and a lower horizontal vertebral engagementsurface 2246, which can also improve congruence between the implant 10Sand the vertebral bodies when a lordotic or variable height expansion isdesired. As will be recognized by a person of ordinary skill in the art,any combination of these varied vertebral engagement surfaces can beemployed on either the distal piston 122A, the proximal piston 122B, thearticulating top plate 113 or the posterior surface of the housing 111to provide optimal vertebral body congruency.

The features of the current invention have been described in terms of animplant comprised of a pair of cylinder/piston/lock/and relatedfeatures, however it is obvious to those schooled in the art that thedescribed features can be included in an implant with only a single setor more than two sets of these features.

A lateral cage implant, as illustrated for exemplary embodiments of thepresent invention herein, is particularly advantaged by the use ofanchors as described herein because the lateral approach to the spine isa long and narrow approach, which limits the ability of the surgeon touse other instrumentation to extend anchors from the cage (as can bedone more readily, for example, with an anterior approach where theaccess is not as narrow). However, as will be appreciated by persons ofordinary skill in the art, while particular, additional advantages maybe presented in connection with the lateral approach and cages designedtherefore, anchors according to embodiments of the present invention areadvantageous for any approach as they can produce the required extensionforces regardless of patient anatomy or other restrictions on the use ofalternative extension means by the surgeon.

Elements of the description herein focused on the manner in which thelocking elements are configured to lock the implant in extendedconfigurations. Although this locking action resists the forces placedon the implant that would tend to force it back into a collapsedconfiguration, that is not the only force the locking elements address.Once inserted between vertebral bodies the implant is subject to lateralforces and torsion moments as well as compressive forces. The lockingfeatures along with the other elements of the invention are designed toresist all of these forces to provide an implant that provides stablefixation and distraction.

A partial or complete discectomy is usually performed prior to theinsertion of the spinal implant having features of the invention betweenvertebral bodies. The implant is introduced in its unexpanded state toenable it to be inserted posteriorly with minimal trauma to the patientand risk of injury to nerve roots. Once in place the implant can beexpanded to provide both medial and lateral spinal correction. Theimplant has an unexpanded height of about 5 to about 15 mm, typicallyabout 7 mm and is expandable to at least 130% to about 180% of theunexpanded height. Typically the implant is about 9 to about 15 mm wide,typically about 12 mm wide and about 25 to about 55 mm long, typicallyabout 35 mm long to facilitate minimally invasive insertion and therebyminimize trauma to the patient and risk of injury to nerve roots.

Additional details of the implant such as the attachment of hydrauliclines and lines for transmission of a slurry or liquid bone graftmaterial, device and hydraulic fluid delivery accessories and the likecan be found in co-pending application Ser. No. 11/535,432 filed on Sep.26, 2006 and Ser. No. 11,692,800, filed on Mar. 28, 2007, which areincorporated herein by reference.

It will be appreciated that the implant, including its variouscomponents should be formed of biocompatible, substantiallyincompressible material such as PEEK or titanium, and preferably type6-4 titanium alloy or other suitable materials which will allow forlong-term deployment within a patient.

While the invention has been described in connection with what arepresently considered to be the most practical and certain preferredembodiments, it is to be understood that the invention is not limited tothe disclosed embodiments and alternatives as set forth above, but onthe contrary is intended to cover various modifications and equivalentarrangements included within the scope of the following claims.

For example, while implants described herein are expanded by hydraulicfluid, other expansion means may be employed. For example, the screwmechanism described herein may be employed to expand scissor jackswithin the implant to engagement adjacent vertebral surfaces. Further,the implant can be provided with load or pressure sensors that registerdifferential pressure and pressure intensity exerted on the engagingsurfaces of the SEC by the patient's vertebrae end plates to generatecorrective signals, for example by computer control, that are used, e.g.by the surgeon or by a computer-controlled mechanism to realign thepatient's spine. The invention may further include a system that makesthese adjustments, responsive to sensor signals, in real time and on acontinual basis, such that the shapes of the implant changes to realignthe patient's spine or mechanism. Preferably, such system iscontemplated for use in setting the positions of the pistons duringinstallation of the implant.

While particular forms of the invention have been illustrated anddescribed herein, it will be apparent that various modifications andimprovements can be made to the invention. Additional details of thespinal implant devices may be found in the patents and applicationsreferenced herein. To the extent not otherwise disclosed herein,materials and structure may be of conventional design.

Moreover, individual features of embodiments of the invention may beshown in some drawings and not in others, but those skilled in the artwill recognize that individual features of one embodiment of theinvention can be combined with any or all the features of anotherembodiment. Accordingly, it is not intended that the invention belimited to the specific embodiments illustrated. It is thereforeintended that this invention be defined by the scope of the appendedclaims as broadly as the prior art will permit.

Terms such as “element”, “member”, “component”, “device”, “means”,“portion”, “section”, “steps” and words of similar import when usedherein shall not be construed as invoking the provisions of 35 U.S.C §112(6) unless the following claims expressly use the terms “means for”or “step for” followed by a particular function without reference to aspecific structure or a specific action. All patents and all patentapplications referred to above are hereby incorporated by reference intheir entirety.

The invention claimed is:
 1. A method for stabilizing a spine in apatient's body, comprising: implanting an expandable fusion implant intoan intervertebral space between a first vertebral body and a secondvertebral body of the spine; expanding the implant to an expandedconfiguration by: moving a first portion of the implant in a lateraldimension such that the width of the implant is increased, and actuatingat least one extendable support element of the implant to drive a firstvertebral engagement surface away from an opposing second vertebralengagement surface in a superior/inferior dimension such that the heightof the implant is increased, the at least one expandable support elementbeing a permanently integral component of the implant that remainsimplanted in the intervertebral space with the implant, wherein the stepof actuating the at least one extendable support element of the implantoccurs non-simultaneously with the step of moving the first portion ofthe implant in the lateral dimension; and locking the implant in theexpanded configuration so as to fix the positions and orientations ofthe first and second vertebral engagement surfaces relative to oneanother.
 2. The method of claim 1, wherein actuating the at least oneextendable support element includes extending a piston outwardly from acylinder of the implant.
 3. The method of claim 1, wherein actuating theat least one extendable support element includes extending a firstextendable support element and a second extendable support elementoutwardly from a housing of the implant.
 4. The method of claim 1,further comprising locking the implant so as to restrain the width ofthe implant from decreasing.
 5. The method of claim 1, wherein movingthe first portion of the implant in the lateral dimension includesextending a piston outwardly from a cylinder of the implant.
 6. Themethod of claim 5, wherein a housing of the implant includes a centralmember that provides the cylinder and receives the piston.
 7. The methodof claim 1, wherein moving the first portion of the implant in thelateral dimension includes extending a lateral anchor outwardly from ahousing of the implant so as to anchor the lateral anchor in laterallyoriented tissue of the patient's body.
 8. The method of claim 1, furthercomprising extending at least one bone anchor outwardly from a housingof the implant, the at least one bone anchor having a sharp tip forfirmly engaging at least one of the first and second vertebral bodies.9. The method of claim 1, wherein the step of actuating the at least oneextendable support element to drive the first vertebral engagementsurface away from the second vertebral engagement surface causes thefirst vertebral body to distract away from the second vertebral body.10. The method of claim 1, further comprising filling an interior cavityof the implant with bone graft material.
 11. A device for stabilizing aspine of a patient's body, comprising: an expandable fusion implantadapted to be implanted into an intervertebral space between a firstvertebral body and a second vertebral body of the spine, the implantincluding a first vertebral engagement surface adapted to engage thefirst vertebral body and an opposing second vertebral engagement surfaceadapted to engage the second vertebral body, and the implant beingexpandable to an expanded configuration by increasing the width of theimplant and increasing the height of the implant; wherein a firstportion of the implant is movable in a lateral dimension such that thewidth of the implant is increased; wherein the implant includes at leastone extendable support element actuatable to drive the first vertebralengagement surface away from the second vertebral engagement surface ina superior/inferior dimension such that the height of the implant isincreased, the at least one extendable support element being apermanently integral component of the implant that remains implanted inthe intervertebral space with the implant, wherein the at least oneextendable support element is actuatable to drive the first vertebralengagement surface away from the second vertebral engagement surfacenon-simultaneously from movement of the first portion in the lateraldimension, and; wherein the implant is lockable in the expandedconfiguration so as to fix the positions and orientations of the firstand second vertebral engagement surfaces relative to one another. 12.The device of claim 11, wherein the at least one extendable supportelement includes a piston adapted to extend outwardly from a cylinder ofthe implant in the superior/inferior dimension.
 13. The device of claim11, wherein the at least one extendable support element includes a firstextendable support element and a second extendable support element, boththe first and second extendable support elements being adapted to extendoutwardly from a housing of the implant.
 14. The device of claim 11,further comprising a locking mechanism adapted to lock the first portionof the implant so as to restrain the width of the implant fromdecreasing.
 15. The device of claim 11, wherein the first portion of theimplant includes a piston adapted to extend outwardly from a cylinder ofthe implant in the lateral dimension.
 16. The device of claim 15,wherein a housing of the implant includes a central member that providesthe cylinder and receives the piston.
 17. The device of claim 16,wherein the central member divides an interior cavity of the housinginto two cavities.
 18. The device of claim 11, wherein the first portionof the implant includes a lateral anchor extendable outwardly from ahousing of the implant in the lateral dimension so as to anchor thelateral anchor in laterally oriented tissue of the patient's body. 19.The device of claim 11, further comprising at least one bone anchorextendable outwardly from a housing of the implant in thesuperior/inferior dimension, the at least one bone anchor having a sharptip for firmly engaging at least one of the first and second vertebralbodies.
 20. The device of claim 19, wherein the at least one bone anchoris formed as a spike.